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Síndrome do túnel do carpo

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Последний просмотренный: 16 Aug 2025
Last updated: 15 Apr 2025

Резюме

Определение

Анамнез и осмотр

Ключевые диагностические факторы

  • presença de fatores de risco
  • dormência na(s) mão(s)
  • piora durante a noite
  • dormência na distribuição do nervo mediano
  • dormência confinada ao aspecto palmar dos 4 primeiros dedos
Полная информация

Другие диагностические факторы

  • sintomas intermitentes
  • início gradual
  • fraqueza na mão
  • falta de coordenação
  • desconforto e dor no braço
  • fraqueza dos músculos tenares (principalmente do abdutor curto do polegar [ACP])
  • reflexos normais
  • rigidez do dedo
  • sensibilidade ao frio
  • atrofia da eminência tenar
Полная информация

Факторы риска

  • idade de 40-60 anos
  • índice de massa corporal (IMC) alto
  • sexo feminino
  • punho/ossos carpais fraturados
  • punho "quadrado"
  • artrite reumatoide
  • diabetes
  • gestação
  • estenose congênita do túnel do carpo
  • exposição ocupacional
  • tabagismo
  • distúrbios da tireoide
  • uso significativo de computador
Полная информация

Диагностические исследования

Исследования, которые показаны в первую очередь

  • eletromiografia (EMG)
Полная информация

Исследования, проведение которых нужно рассмотреть

  • ultrassonografia do punho
  • ressonância nuclear magnética (RNM) do punho
Полная информация

Алгоритм лечения

Острый

diagnóstico clínico de síndrome do túnel do carpo (STC) sem confirmação de eletromiograma (EMG) ou gestantes

leve ou moderada com base nos achados de eletromiografia (EMG; não gestante)

grave com base nos achados de eletromiografia (EMG; não gestante)

ПРОДОЛЖЕНИЕ

moderado com base nos achados da EMG + insucesso da tala e das injeções de corticosteroides

refratário à cirurgia

Составители

Авторы

Nigel Ashworth, MBChB, MSc, FRCP(Can)
Nigel Ashworth

Professor

Division of Physical Medicine & Rehabilitation

Faculty of Medicine & Dentistry

University of Alberta

Edmonton

Canada

Раскрытие информации

NA is an author of a number of references cited in this topic.

Рецензенты

Ines C. Lin, MD, MSEd

Associate Professor of Surgery

Division of Plastic Surgery, Department of Surgery, and Department of Orthopaedic Surgery

Perelman School of Medicine at the University of PennsylvaniaPhiladelphia

PA

Раскрытие информации

ICL declares that she has no competing interests.

Peter C. Amadio, MD

Dean for Research Academic Affairs

Lloyd A. and Barbara A. Amundson Professor of Orthopedic Surgery

Professor of Biomedical Engineering

Mayo Clinic

Rochester

MN

Раскрытие информации

PCA declares that he has no competing interests.

Shawn Marshall, MD, MSc

Associate Professor

University of Ottawa

Ottawa

Ontario

Canada

Раскрытие информации

SM declares that he has been primary author and co-author of Cochrane systematic reviews of nonsurgical interventions for treatment of carpal tunnel syndrome.

Tim J. Doherty, MD, PhD

Associate Professor

The University of Western Ontario

London

Ontario

Canada

Раскрытие информации

TJD declares that he has no competing interests.

Michael Plant, MD, FRCP

Consultant Rheumatologist

The James Cook University Hospital

South Tees Hospitals NHS Foundation Trust

Middlesbrough

UK

Disclosures

MP declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Cartwright MS, Hobson-Webb LD, Boon AJ, et al; American Association of Neuromuscular and Electrodiagnostic Medicine. Evidence-based guideline: neuromuscular ultrasound for the diagnosis of carpal tunnel syndrome. Muscle Nerve. 2012 Aug;46(2):287-93. Abstract

Ashworth NL, Bland JDP, Chapman KM, et al. Local corticosteroid injection versus placebo for carpal tunnel syndrome. Cochrane Database Syst Rev. 2023 Feb 1;2(2):CD015148.Full text  Abstract

Peters S, Page MJ, Coppieters MW, et al. Rehabilitation following carpal tunnel release. Cochrane Database Syst Rev. 2016 Feb 17;(2):CD004158.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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